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Purpose Prostate brachytherapy (BT) is a validated treatment for localized prostate cancer (CaP) and an attractive therapy option for patients seeking to preserve erectile function (EF). The aim of this paper is to prospectively assess EF evolution during 4 years after BT. Material and methods Between February 2007 and July 2012, 179 patients underwent an exclusive Iodine-125 BT, for low-intermediate favorable risk CaP of whom, 102 had an initial international index of erectile function 5 score (IIEF-5) > 16 and were included in the study. Of those, 12.7% received neo-adjuvant hormonotherapy (HT) to decrease the prostate volume. Post-BT intake of phosphodiesterase inhibitors (PDE5i) was not an exclusion criterion. Erectile function was prospectively assessed using a validated questionnaire IIEF-5 before treatment and annually for 4 years. Results At 1-year follow-up, 54% of patients preserved an IIEF-5 > 16 and only 8% suffered from severe ED. During the next 3 years, the results were not statistically different. The mean IIEF-5 lost 4 points during the first year, 17 vs. 21, and remained stable during the following 3 years. We did not find any significant differences in the proportion of patients treated by PDE5i (18-20%). As for patients with a normal preoperative IIEF-5 (> 21) (n = 52), 35-42% preserved a normal EF and 71-77% maintained an IIEF-5 > 16, including 13-19% of patients who needed PDE5i. Those results were stable for over 4 years. Conclusions During the first 4 years after BT, more than half of patients maintained an IIEF-5 > 16, and EF results remained stable. Severe erectile dysfunction (ED) was very rare.

Purpose Brachytherapy (BrT) is a standard treatment for low-risk to favorable-intermediate-risk prostate cancer but is a relative contraindication for patients with obstructive symptoms. We aimed to assess the feasibility and urinary toxicity of a minimal photovaporization (mPVP) before implantation. Materials and Methods Between 04/2009 and 08/2016, 50 patients candidates for BrT but with International Prostate Symptom Score (IPSS)>15, uroflowmetry Results Two patients (4%) did not have sufficient improvement and did not undergo BrT, although it would have been possible at 3 months. For the 48 (96%) other patients, at the baseline, mean IPSS was 15.5 (±5.3), vs. 8.6 (±4.4) after mPVP (p = 1 × 10−6), and uroflowmetry 11.7 mL/s (±4), vs. 17.4 (±5.4) (p = 1.4 × 10−5). We did not experience any difficulty for BrT. Mean IPSS did not significantly increase 1, 3, or 6 months after BrT. With a median followup of 60 months [30–120], (92% assessed at last followup), only 4 patients (4/48 = 8.3%) experienced urinary retention and 5 (10.4%) needed surgery for urinary toxicity. In addition, only 2 patients (4%) needed medical treatment at last followup. Considering the 8 patients with de novo incontinence at 1 year, only 2 (4%) had persistent mild symptoms at last followup (36 months) (ICS1-2). Conclusions These results suggest that a two-step approach with an mPVP at least 6 weeks before BrT is feasible, with no excessive urinary toxicity, and may be a good strategy for obstructive patients seeking BrT.

Direct outcrop observation and field data collection are key techniques in research, teaching and outreach activities in volcanic areas. However, very often outcrops are of difficult or impossible access, such as in areas with active volcanoes or steep cliffs. Classical remote-sensing surveys by satellites or airplanes are expensive, rarely reach sufficient resolution to allow high-quality 3D visualisation of volcanic features and do not facilitate mapping of vertical cliffs. We describe a novel approach that uses immersive Virtual Reality (VR) based on real-world 3D Digital Outcrop Models (DOMs) from images surveyed by “unoccupied aerial system” (UAS). 3D DOMs are built up using the Structure-from-Motion (SfM) photogrammetry technique, and a VR scene is created using game engine technologies. Immersive real-time exploration of the environment is possible through a head-mounted display, e.g. Oculus Rift. Tools embedded in the VR environment allow the user to map polygons, lines and point features. Tools also allow to measure orientation, dip, inclination, azimuth, area and thickness and even take virtual photographs. Using three examples of volcanic areas with different geological features, we demonstrate the potential of our approach to allow users to be able to virtually map and measure remotely, and to collect data for research and teaching. Our approach is of paramount importance also for outreach, as it allows non-specialist audiences (e.g. common citizens) to experience and appreciate highly complex volcanic features through customised, hands-on immersive VR tools. © 2020, International Association of Volcanology & Chemistry of the Earth's Interior.

The PELGRIMM project was a FP7-European project (funded by the European Commission , Grant Agreement No. 295664 ), carried out from 2012 to 2017. It was devoted to the investigation of spherepacked and pelletized fuel forms for Minor Actinide transmutation in homogeneous and heterogeneous recycling modes. PELGRIMM aimed at constituting a new step in the long term process in the assessment of Minor Actinide-bearing fuel, initiated within the European projects ACSEPT, F-BRIDGE, CP-ESFR and FAIRFUELS. The present paper provides an overview of the main technical outcomes gained within PELGRIMM. The developments of alternative processes in order to simplify synthesis routes and to limit secondary waste streams for Minor Actinide-bearing fuel preparation are detailed. The first results of behaviour under irradiation of spherepacked and pelletized fuel forms are provided from Post-Irradiation Examinations on (U,Pu,Am)O2 and (U,Am)O2 fuels respectively irradiated during SPHERE and MARIOS experiments, along with the description of the latest irradiation experiment, MARINE. In parallel, the capabilities of existing models and calculation codes have been improved to describe Minor Actinide-bearing fuel behaviour under irradiation in a more reliable way, and their predictive results have been compared to available Post-Irradiation Examinations. Finally, to start linking fuel behaviour with core neutronic problematics, a preliminary design of a Sodium-cooled Fast Reactor core loaded with spherepacked (U,Pu,Am)O2 fuels was built and correlated preliminary safety assessments have been performed.

International audience; Americium is a strong contributor to the long term radiotoxicity of high activity nuclear waste.Transmutation by irradiation in nuclear reactors of long-lived nuclides like $^{241}$Am is therefore an option for the reduction of radiotoxicity and heat production of waste packages to be stored in a repository. The MARINE irradiation experiment is the latest of a series of European experiments on americium transmutation (e.g. EFTTRA-T4, EFTTRA-T4bis, HELIOS, MARIOS, SPHERE) performed in the High Flux Reactor (HFR). The MARINE experiment is developed and carried out in the framework of the collaborative research project PELGRIMM of the EURATOM 7th Framework Programme (FP7). During the past years of experimental works in the field of transmutation and tests of innovative nuclear fuels, the release or trapping of helium as well as swelling have been shown to be the key issues for the design of such kind of fuel both as drivers and even more for Am-bearing blanket targets (due to the higher Am contents). The main objective of the MARINE experiment is to study the in-pile behaviour of uranium oxide fuel containing 13% of americium and to compare the behaviour of sphere-pac versus pellet fuel, in particular the role of microstructure and temperature on fission gas release and He on fuel swelling.The MARINE experiment will be irradiated in 2016 in the HFR in Petten (The Netherlands) and is expected to be completed in spring 2017. This paper discusses the rationale and objective of the MARINE experiment and provides a generaldescription of its design for which some innovative features have been adopted.

International audience; Mixed uranium-americium oxides are one of the materials envisaged for Americium Bearing Blankets dedicated to transmutation in fast neutron reactors. Conversion and fabrication processes are currently developed to make those materials in the form of dense and homogeneous oxide ceramic pellets or dense granulates incorporating uranium and americium. Their development points out the need of a simplified and optimized process which could lower hazards linked to dust generation of highly contaminating and irradiating compounds and facilitate material transfer in remote handling operations. This reason motivated the development of innovative “dustless” route such as the Weak Acid Resin route (WAR) which provides the oxide precursors in the form of sub-millimeter-sized microspheres with optimal flowability and limits dust generation during conversion and fabrication steps. This study is thus devoted to the synthesis of mixed uranium-americium oxide microspheres by the WAR process and to the characterization of such precursors. This work also deals with their application to the fabrication of dense or porous pellets and with their potential use as dense spherules to make Sphere-Pac fuel.

Purpose “Quadrella” index has been recently developed to assess oncological and functional outcomes after prostate brachytherapy (PB). We aimed to evaluate this index at 1, 2, and 3 years, using validated questionnaires, assessed prospectively. Methods and Materials From 08/2007 to 01/2013, 193 patients underwent 125Iodine PB for low-risk or favorable intermediate-risk prostate adenocarcinoma. Inclusion criteria were as follows: no incontinence (International Continence Society Index initial score = 0) and good erectile function (International Index of Erectile Function–5 items: >16). One hundred patients were included (mean age: 64 y). Postimplantation intake of phosphodiesterase inhibitors was not considered as failure. The “Quadrella” index was defined by the absence of biochemical recurrence (Phoenix criteria), significant erectile dysfunction (ED) (Index of Erectile Function–5 items: >16), urinary toxicity (UT) (International Prostate Score Symptom [IPSS] 15 with ΔIPSS Results At 12 months, 90 patients were evaluable: 42/90 (46.7%) achieved Quadrella. The main criteria for failure were as follows: ED in 77.1% (37/48) of cases, RT in 20.8% (10/48) of cases, and UT in 12.5% (9/57) of cases. At 24 and 36 months, 59.3% (48/81) and 61.1% (44/72) of patients achieved Quadrella, respectively. The main cause of failure was ED in 69.7% (23/33) and 85.7% (24/28) of cases, while RT was involved in 21.2% (7/33) and in 3.6% (1/28) of cases, and UT in 9.1% (3/33) and 3.6% (1/28) of cases. Only one case of biochemical recurrence was observed (i.e., 1/28 = 3.6% at 3 y). Conclusions The Quadrella can be used at 1, 2, and 3 years after PB. It allows to take into account the urinary and RT specific to PB. ED was the main cause of failure. This index will be useful to assess midterm and long-term results.

Americium is a strong contributor to the long term radiotoxicity of high activity nuclear waste. Transmutation by irradiation in nuclear reactors of long-lived nuclides like 241 Am is therefore an option for the reduction of radiotoxicity of waste packages to be stored in a repository. The SPHERE irradiation experiment is the latest of a series of European experiments on americium transmutation (e.g. EFTTRA-T4, EFTTRA-T4bis, HELIOS, MARIOS) performed in the HFR (High Flux Reactor). The SPHERE experiment is carried out in the framework of the 4-year project FAIRFUELS of the EURATOM 7th Framework Programme (FP7). During the past years of experimental works in the field of transmutation and tests of innovative nuclear fuels, the release or trapping of helium as well as helium induced fuel swelling have been shown to be the key issues for the design of Am-bearing targets. The main objective of the SPHERE experiment is to study the in-pile behaviour of fuel containing 3% of americium and to compare the behaviour of sphere-pac fuel to pellet fuel, in particular the role of microstructure and temperature on fission gas release (mainly He) and on fuel swelling. The SPHERE experiment is being irradiated since September 2013 in the HFR in Petten (The Netherlands) and is expected to be terminated in spring 2015. The experiment has been designed to last up to 18 reactor cycles (corresponding to 18 months) but may reach its target earlier. This paper discusses the rationale and objective of the SPHERE experiment and provides a general description of its design.

The MARIOS irradiation experiment is the latest in a series of experiments on americium transmutation, and has been carried out in the framework of EURATOM’s 7th Framework Programme (FP7) project FAIRFUELS, which started the 1st January 2009 and is still ongoing. The Post Irradiation Examination (PIE) of MARIOS samples will be performed under the PELGRIMM project. The transmutation of Minor Actinides (MA) is a fundamental step in order to be able to close the nuclear fuel cycle. One of the attractive possibilities to burn MA, is represented by the Minor Actinides Bearing Blanket (MABB) concept. In this option, MA are diluted in a UO2 matrix and irradiated for a long time (from 2000 to 4100 days) in radial blankets at the periphery of the outer core of a Sodium Fast Reactor (SFR). Past experimental activities in the field of transmutation and testing of innovative nuclear fuel containing Am has proved that the release or trapping of helium as well as the studies on the swelling of such kind of fuel is a key issue for its safety design. Therefore, the main objective of the MARIOS experiment is the study of the in-pile behaviour of UO2 (with natural uranium) containing Am as minor actinide in order to gain knowledge on the role of the microstructure and of the temperature on the gas release and on fuel swelling for the MABB concept. The MARIOS irradiation experiment started on the 19th of March 2011 and finished on the 2nd of May 2012 after 11 reactor cycles (304 full power days) in the HFR (High Flux Reactor) in Petten (The Netherlands). The MARIOS irradiation experiment will determine the performance of the MABB fuel, the behaviour of such targets during the irradiation did not show any anomalies. It is possible to conclude that from an operational point of view, these kinds of fuel which have been developed mainly having in mind the possibility to burn MA in a blanket at the periphery of a Sodium Fast Reactor, did not show significant issues. This paper summarises the main experimental data obtained after the 11-cycle irradiation of the MARIOS experiment in the HFR., JRC.F.4-Nuclear Reactor Integrity Assessment and Knowledge Management

The main challenge for fuels for future Sodium Fast Reactor systems is the development and qualification of a nuclear fuel sub-assembly which meets the Generation IV International Forum goals. The Advanced Fuel project investigates high burn-up minor actinide bearing fuels as well as claddings and wrappers to withstand high neutron doses and temperatures. The R&D outcome of national and collaborative programs has been collected and shared between the AF project members in order to review the capability of sub-assembly material and fuel candidates, to identify the issues and select the viable options. Based on historical experience and knowledge, both oxide and metal fuels emerge as primary options to meet the performance and the reliability goals of Generation IV SFR systems. There is a significant positive experience on carbide fuels but major issues remain to be overcome: strong in-pile swelling, atmosphere required for fabrication as well as Pu and Am losses. The irradiation performance database for nitride fuels is limited with longer term R&D activities still required. The promising core material candidates are Ferritic/Martensitic (F/M) and Oxide Dispersed Strengthened (ODS) steels.

Objectives To assess the impact of lymphovascular invasion (LVI) on upper urinary tract urothelial carcinomas (UTUCs) in a multicentre study on cancer-specific survival (CSS), recurrence-free survival and metastasis-free survival (MFS). To show the negative impact of LVI for patients with pN0/x disease and to stratify these patients into risk groups for metastatic relapse. Patients and Methods A multicentre retrospective study was performed on patients who underwent radical nephroureterectomy between 1995 and 2010. LVI status was evaluated as a prognostic factor for survival using univariate and multivariate Cox regression analysis. Results Overall, 551 patients were included and were divided into two groups: those without LVI (LVI−), n = 388 and those with LVI (LVI+), n = 163. LVI+ status was associated with high stage and grade UTUC and lymph node metastasis (P

To assess the impact of experience and technical changes on peri- and postimplantation (1 month later) dosimetry for permanent prostate brachytherapy (PPB). From July 2003 to May 2010, 150 prostate cancer patients underwent low-dose, loose-seed I125 PPB as monotherapy with intraoperative planning. Patients were divided into three groups—P1 (n = 64), P2 (n = 45), P3 (n = 41)—according to the technical changes that occurred during the study period: use of an automatic stepper at the beginning of P2 and a high-frequency ultrasound probe in P3. Peri- and postimplantation dosimetric parameters (on day 30) were reported: D90 (dose received by 90% of prostate volume), V100 and V150 (prostate volume receiving, respectively, 100% and 150% of the prescribed dose), D2 cc and D0.1 cc (doses received by 2 cc and 0.1 cc of the rectum), R100 (rectum volume that received 100% of the prescribed dose), and D10 and D30 (doses received by 10% and 30% of the urethra, only during peri-implantation). We observed a decrease in the number of needles and seeds used over time. The mean peri-implantation D90 was 187.52 Gy without a significant difference between the three periods (p = 0.48). The postimplantation D90, V100, and V150 parameters were, respectively, 168.3 Gy, 91.9%, and 55% with no significant difference between the three periods. The peri-implantation and postimplantation D0.1 cc and R100 significantly decreased over time; on day 30: D0.1 cc P1 = 223.1 Gy vs. D0.1 cc P3 = 190.4 Gy (p = 8.10− 5) and R100 P1 = 1.06 cc vs. R100 P3 = 0.53 cc (p = 0.0008). We observed a learning curve for the implantation parameters, which led to a significant decrease in the rectal doses without having any impact on the prostate dosimetric parameters.

Study Type – Prognosis (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Upper urinary tract urothelial carcinoma (UUT-UC) is a rare disease, usually treated by nephroureterectomy, occurring in a population with a median age of 70 years and with frequent tobacco use and other comorbidities. We know that the American Society of Anesthesiologists (ASA) score has prognostic value in urological oncology but this has not been assessed in UUT-UC. Using a multi-institutional French database, we have shown that the 5-year cancer-specific survival differed significantly between ASA 1, ASA 2 and ASA 3 patients (83.8%, 76.9% and 70.6%, respectively; P= 0.01). ASA status had a significant impact on cancer-specific survival in univariate and multivariate analyses, with a threefold higher risk of mortality at 5 years for ASA 3 compared with ASA 1 patients (P= 0.04). OBJECTIVE • To evaluate the impact of American Society of Anesthesiologists (ASA) scores on the survival of patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UUT-UC). PATIENTS AND METHODS • A retrospective multi-institutional cohort study of the French collaborative national database of UUT-UC treated by RNU in 20 centres from 1995 to 2010. • The influence of age, gender and ASA score on survival was assessed using a univariable and multivariable Cox regression analysis with pathological features used as covariables. RESULTS • Overall, 554 patients were included. The median follow-up was 26 months (10–48 months), and the median age was 69.5 years (61–76 years). In total, 114 (20.6%) patients were classified as ASA 1, 326 (58.8%) as ASA 2 and 114 (20.6%) as ASA 3. • The 5-year recurrence-free survival (P= 0.21) and metastasis-free survival (P= 0.22) were not significantly different between ASA 1 (52.8% and 76%), ASA 2 (51.9% and 75.3%) and ASA 3 patients (44.1% and 68.2%, respectively). • The 5-year cancer-specific survival differed significantly between ASA 1, ASA 2 and ASA 3 patients (83.8%, 76.9% and 70.6%, respectively; P= 0.01). • ASA status had a significant impact on cancer-specific survival in univariate and multivariate analyses, with a threefold higher risk of mortality at 5 years for ASA 3 compared with ASA 1 patients (P= 0.04). CONCLUSIONS • ASA classification correlates significantly with cancer-specific survival after RNU for UUT-UC. • It is a further pre-operative clinical variable that can be incorporated into future risk prediction tools for UUT-UC to improve their accuracy.

BACKGROUND: Although much has been done to examine those factors associated with higher mortality among African American women, there is a paucity of literature that examines disparities among rural African Americans in South Carolina. The purpose of this investigation was to examine the association of race and mortality among breast cancer patients in a large cohort residing in South Carolina for which treatment regimens are standardized for all patients. METHODS: Subjects included 1209 women diagnosed with breast cancer between 2000 and 2002 at a large, local hospital containing a comprehensive breast center. Kaplan-Meier survival curves were calculated to determine survival rates among African American and European American women, stratified by disease stage or other prognostic characteristics. Adjusting for various characteristics, Cox multivariate survival models were used to estimate the hazard ratio (HR). RESULTS: The 5-year overall all-cause mortality survival proportion was ∼78% for African American women and ∼89% for European American women, P < 0.01. In analyses of subpopulations of women with identical disease characteristics, African American women had significantly higher mortality than European American women for the same type of breast cancer disease. In multivariate models, African American women had significantly higher mortality than European American women for both breast cancer-specific death (HR, 2.41; 95% confidence interval [CI], 1.21-4.79) and all-cause mortality (HR, 1.42; 95% CI, 1.06-1.89). CONCLUSIONS: African American women residing in rural South Carolina had lower survival for breast cancer even after adjustment for disease-related prognostic characteristics. These findings support health interventions among African American breast cancer patients aimed at tertiary prevention strategies or further down-staging of disease at diagnosis. Cancer 2011. © 2011 American Cancer Society.

The E uropean F acility for I ndustrial T ransmutation (EFIT) has been developed within the 6th EU Framework by the EUROTRANS Program, aiming at a generic conceptual design of an accelerator driven transmuter. This paper deals with assessments of EFIT cores with CERCER and CERMET fuels from the viewpoint of core performance and safety. The conclusive remarks can be drawn as follows. Because of its much better thermal conductivity, the CERMET core can be designed by using thicker pins, so that it has the same or even better transmutation performance compared to the CERCER core. Both CERCER and CERMET fuels fulfill safety requirements. Moreover the CERMET fuel has higher fuel safety margins than the CERCER one. Preliminary analyses show that the CERMET total core power can be further increased by 50% at least without exceeding fuel and clad temperature limits.

The HELIOS irradiation experiment is the latest of a series of experiments on americium transmutation, and has been carried out in the framework of EURATOM's 6th Framework Programme (FP6) project EUROTRANS, which has been completed in March 2010. The transmutation of Minor Actinide (MA) is a fundamental step in order to be able to close the cycle of the nuclear fuel. Past experimental activities in the field of transmutation and testing of innovative nuclear fuel containing Am has proved that the release or trapping of helium is a key issue for the design of such kind of fuel or targets. Therefore, the main objective of the HELIOS experiment is the study of the in-pile behaviour of U-free fuels such as (Pu,Am,Zr,Y)O2 or (Am,Zr,Y)O2, CERCER (Am2Zr2O7+MgO), CERMET ((Pu,Am)O2+Mo) or ((Am,Zr,Y)O2+Mo) in order to gain knowledge on the role of the fuel microstructure and of the operating temperature on gas release and fuel swelling. The HELIOS irradiation experiment started in the HFR (High Flux Reactor) in Petten (The Netherlands) on the 29th of April 2010 and finished on the 19th of February after 9 reactor cycles (~241 full power days). Although only the Post Irradiation Examination (not performed yet) conducted on the CERCER and CERMET target fuel tested during the HELIOS irradiation experiment will show the performance of the fuel, the behaviour of such targets during the irradiation did not show any difficulties. It is possible to conclude that from an operational point of view, these kinds of fuel targets which have been developed mainly having in mind the possibility to burn MA in a in a subcritical nuclear system, did not show significant issues. This paper summarises the main experimental data obtained during the 9-cycle irradiation of the HELIOS experiment in the HFR., JRC.F.4-Safety of future nuclear reactors

In the framework of the Generation IV Sodium Fast Reactor (SFR) Program the Advanced Fuel Project has conducted an evaluation of the available fuel systems supporting future sodium cooled fast reactors. In this paper the status of available and developmental materials for SFR core cladding and duct applications is reviewed. To satisfy the Generation IV SFR fuel requirements, an advanced cladding needs to be developed. The candidate cladding materials are austenitic steels, ferritic/martensitic (F/M) steels, and oxide dispersion strengthened (ODS) steels. A large amount of irradiation testing is required, and the compatibility of cladding with TRU-loaded fuel at high temperatures and high burnup must be investigated. The more promising F/M steels (compared to HT9) might be able to meet the dose requirements of over 200 dpa for ducts in the GEN-IV SFR systems.

In the framework of the Generation IV Sodium Fast Reactor Program, the Advanced Fuel Project has conducted an evaluation of the available fuel systems supporting future sodium cooled fast reactors. This paper presents an evaluation of metallic alloy fuels. Early US fast reactor developers originally favored metal alloy fuel due to its high fissile density and compatibility with sodium. The goal of fast reactor fuel development programs is to develop and qualify a nuclear fuel system that performs all of the functions of a conventional fast spectrum nuclear fuel while destroying recycled actinides. This will provide a mechanism for closure of the nuclear fuel cycle. Metal fuels are candidates for this application, based on documented performance of metallic fast reactor fuels and the early results of tests currently being conducted in US and international transmutation fuel development programs.

European R&D for ADS design and fuel development is driven in the 6th FP of the EU by the EUROTRANS Programme. In EUROTRANS two ADS design routes are followed, the XT-ADS and the EFIT The XT-AD ...

Resume Introduction Les fistules aorto-duodenales sont des complications rares et severes de la chirurgie de prothese vasculaire. Elles sont habituellement revelees par des manifestations digestives et une fievre, contrairement a notre observation ou existaient seulement des localisations septiques cutanees et une grosse jambe rouge aigue febrile. Observation Un homme de 59 ans, aux antecedents de prothese aorto-bi-iliaque posee 6 ans plus tot pour un anevrysme sous-renal, etait hospitalise en dermatologie pour une fievre evoluant depuis 3 mois et une grosse jambe gauche rouge aigue inflammatoire prenant le godet. Deux nodules sous-cutanes y etaient palpables et apparaissaient hypervascularises a l’echographie. Un scanner abdomino-pelvien revelait une compression de la veine iliaque gauche par des remaniements inflammatoires periprothetiques et surtout des collections retroperitoneales, dont certaines renfermaient des bulles de gaz faisant suspecter une fistule aorto-duodenale. Ce diagnostic etait confirme en peroperatoire. Les prelevements profonds etaient positifs pour E. coli et Candida glabatra . Discussion Les fistules aorto-duodenales sont des complications rares mais severes des protheses vasculaires. Le tableau clinique comprend habituellement des symptomes digestifs et de la fievre. Cependant les signes peuvent etre plus trompeurs faisant errer le diagnostic et retardant la prise en charge chirurgicale. Les signes cutanes sont d’apparition tardive et rarement isoles comme chez notre malade. Ils traduisent des phenomenes emboliques ou compressifs. C’est le traitement chirurgical qui confirme le diagnostic et apporte une solution therapeutique.

To evaluate erectile function (EF) prospectively from 1 to 2 years post-brachytherapy in patients with a baseline IIEF5 score16.Between 2007 and 2012, 179 patients underwent an exclusive brachytherapy for localised low risk prostate adenocarcinoma. Neo-adjuvant hormotherapy (15.6%) and post-brachytherapy intake phosphodiesterase inhibitors (PDE5i) were not considered as exclusion criteria. EF was evaluated via a scoring questionnaire IIEF5 before the surgical implantation, at month 12 and 24 post-operation. Only patients with an initial IIEF5 score16 were included.Of the 179 patients, 102 (57%) had a baseline IIEF516. At 12 months, 51.1% maintained an IIEF516 and 24.5% had a mild to moderate erectile dysfunction (ED), so that a total of 75.6% with IIEF5≥12. About 18% of patients had used PDE5i. At 24 months, 53.2% had an IIEF516 and 80.6% had an IIEF5≥12. Severe ED was reported in only 14.5% of the patients. The mean IIEF5 was 16.2 with an average decline of 5 points from the initial stage. All patients who were treated with PDE5i (27%) could have sexual intercourse. EF at baseline was reported as the only predictive factor of ED in multivariate analysis, 70% of patient without ED initially, had an IIEF516 at 1 and 2 years.Severe ED was quite rare (14%) during the first 2 years post-brachytherapy and more than half of patients maintained an IIEF516. The main predictive factor was the erectile function at baseline.4.

An experimental and theoretical study was carried out to predict the warming and the mass-transfer rate during adsorption of high concentrations of volatile organic compounds (VOCs) in an activated carbon bed. A linear driving force (LDF) model is found to provide an acceptable fit to the measured data. An empirical correlation of the mass transfer rate is proposed as a function of the strength of adsorbent−adsorbate interactions and the gas velocity to design the adsorption process without using any adjustable parameter. The model was validated for an adsorption unit with high loadings (up to 100 g.m-3) of seven kinds of VOC and within the velocity range 0.139−0.556 m.s-1. The prediction of the temperature rise inside the adsorber is improved by the use of the differential heat of adsorption instead of the integral heat. A theoretical parameter sensitivity test indicates that the temperature rise is strongly dependent on the molar VOC concentration, the adsorption heat, and the volumetric heat capacity o...

Thermal waves resulting from the dynamic adsorption of organic vapor present in air on a granular activated carbon (GAC) filter were studied. An experimental design was carried out to determine the influential factors among the relative humidity of air (0–60%), the initial water content of the activated carbon (0–9.8%), and the volatile organic compound (VOC) concentration (0–50 g⋅m−3, i.e., 0–20,700 ppmv for acetone). The temperature increase is a function of the initial VOC concentration as well as the energy flux released. The warming of the adsorber is shown to be important for the adsorption of high VOC concentrations on a dry carbon bed, but the thermal amplitude is distinctly reduced when the GAC is initially wet because of water desorption. The moisture content of the air in the range of 0–95% is not found to be a prominent factor affecting both the adsorption capacity and the warming of the GAC bed for the high VOC concentration tested (20,700 ppmv of acetone). Temperature monitoring provides int...

Objectifs Pour evaluer l’aspect oncologique et fonctionnel apres curietherapie prostatique (CuT), un « Quadrella » a ete recemment defini (Radiotherapy and Oncology, 2014:110–3). Le but de notre etude etait d’evaluer ce « Quadrella » : survie sans progression, fonction erectile, toxicite urinaire et rectale a 1 et 2 ans. Methodes De 08/2007 a 01/2013, 193 patients ont eu une CuT a bas debit pour un adenocarcinome (CaP) a faible risque ou de risque intermediaire favorable. Nous avons inclus : les bas risques, avec un score ICS initial nul, un score IIEF5 > 16, avec 3 . Cent patients ont pu etre analyses. La realisation du « Quadrella » etait definie par l’absence de recidive biologique (criteres de Phoenix), l’absence de dysfonction erectile significative (IIEF5 > 16), l’absence de toxicite urinaire (IPSS 15 avec ΔIPSS Resultats A 12 mois, 91 patients ont pu etre evalues et parmi eux l’objectif du Quadrella a ete atteint chez 34 patients (37,4 %) qui repondaient a l’ensemble des criteres. Chez 57 patients (62,6 %), l’ensemble des criteres du Quadrella n’etait pas obtenu, les principaux criteres d’echec etaient : la dysfonction erectile (DE) a 80,7 % (46/57), seule a 56,1 % (32/57). La toxicite rectale etait impliquee a 33,3 % (19/57) et la toxicite urinaire a 15,8 % (9/57). A 24 mois ( n = 86), 40,7 % (35/86) repondaient au Quadrella. Parmi les 59,3 % d’echec (51/86), les principales causes etaient : la DE a 72,5 % (37/51), la toxicite rectale a 39,2 % (20/51) et la toxicite urinaire a 13,7 % (7/51). Conclusion Le Quadrella peut etre utilise a 1 et 2 ans apres CuT pour les resultats oncologiques et fonctionnels, et permet a la difference du Trifecta de prendre en compte la symptomatologie mictionnelle et rectale. La toxicite erectile etait la principale cause d’echec du Quadrella apres CuT ( Tableau 1 , Fig. 1 ).

International audience; Future sodium cooled fast reactors (SFRs) with Minor Actinide (MA) burning potential have to demonstrate an enhanced safety, minimal waste production and increased proliferation resistance in addition to their high economical potential. In this context, the PELGRIMM project, part of the European Framework Program 7 (FP7), investigates new MA-bearing oxide fuel developments for SFRs. Two fuel designs are studied: the standard pellet and the innovative sphere-pac fuel. Due to its favorable swelling behavior expected under irradiation and its dustless fabrication, the latter one appears to be a promising option. A special work package in PELGRIMM addresses the safety performance of this fuel under operational, design basis (DBC) and design extension conditions (DEC). For the preliminary safety assessment, the Working Horse (WH) core, designed and analyzed in the former CP-ESFR project was chosen. The SIMMER-III code was applied after implementing key features as the specific thermal conductivity of sphere-pac fuels. The feasibility of loading the core with MOX sphere-pac instead of pellet fuel, regarding operation and safety limitations, was first proven. Both fuel designs for the WH core at beginning of life and after irradiation were then compared at nominal and under unprotected loss of flow conditions. Results show a similar behavior of these fuels under irradiation, opening a perspective to the practical application of sphere-pac fuels in SFR systems. (C) 2015 The Authors. Published by Elsevier Ltd.

International audience; PURPOSE: To assess the impact of experience and technical changes on morbidity during the first year after permanent prostate brachytherapy. METHODS AND MATERIALS: From July 2003 to May 2010, 150 patients with prostate cancer underwent low-dose iodine-125 prostate brachytherapy as a monotherapy by the same medical team (one urologist and one radiation oncologist). Patients were divided into three periods: P1 (n = 64), P2 (n = 45), and P3 (n = 41) according to technical changes: use of an automatic stepper from P2, use of a high-frequency ultrasound probe in P3. Urinary toxicity was analyzed according to the incidence of acute urinary retention (AUR), Delta International Prostate Symptom Score (Δ IPSS) defined as IPPS maximal - IPSS at baseline, and proportion of patients with Δ IPSS ≥5 and IPSS total >15. The Radiation Therapy Oncology Group classification was used to evaluate the rectal morbidity. RESULTS: The incidence of AUR (6% overall) decreased significantly with time: 12.5% (8/64) during P1, 2.2% (1/45) in P2, and 0% in P3 (p = 0.014). Mean Δ IPSS (11.6) remained stable during the three periods. Patients with Δ IPSS ≥5 and IPSS total >15 were 58.7%, 58.1%, and 56.1% for P1, P2, and P3 (p = 0.96), respectively. Grade 1 and 2 proctitis were observed in 15.3% and 9.3% of the patients without any significant difference between the three periods. CONCLUSION: The incidence of AUR decreased significantly with time. This was probably because of the experience of the practitioner and the use of an automatic stepper that allowed reducing prostatic traumatism. Experience and technical changes did not seem to affect rectal morbidity.

The objective of the study was to evaluate the effect of a history of bladder cancer (BC) or synchronous BC on the prognosis and survival of patients who have undergone radical nephroureterectomy (RNU).Using a multi-institutional, retrospective database, we identified 662 patients with upper urinary tract urothelial carcinoma (UUT-UC) treated by radical nephroureterectomy, between 1995 and 2010. We analyzed clinicopathologic characteristics and outcomes according to the history of BC or concomitant BC or both, at the time of diagnosis. BC was evaluated as a prognostic factor for bladder recurrence and survival.Overall, 83 (12.5%) patients had previous BC, 62 (9.4%) exhibited concomitant BC, and 75 (11.3%) presented with both previous and current BC. A history of BC was less seen in women and nonsmokers (P0.0001 and P = 0.013, respectively). The patients with associated BC had more tumors located in the ureter (P0.0001), as well as more multiple locations in the upper tract (P0.0001). The tumors without concomitant BC were more likely to be associated with locally advanced stages (P = 0.024). At a median follow-up time of 37.3 months, 31.4% of patients experienced BC recurrence and 2.9% developed contralateral upper tract tumor. Using multivariate analyses, the previous or synchronous BC (P = 0.01) and positive surgical margins (P = 0.03) are independent prognostic factors for BC recurrence. The metastasis-free survival and cancer-specific survival rates did not significantly differ according to the associated BC status.In patients without previous or concomitant BC, the upper tract tumors are more frequently localized in the renal pelvis and are associated with a more invasive status at the time of diagnosis. Nevertheless, the presence of UUT-UC without previous or synchronous BC did not significantly affect the survival rates after nephroureterectomy.

International audience; Activated carbon fixed beds are classically used to remove volatile organic compounds (VOCs) present in gaseous emissions. In such use, an increase of local temperature due to exothermal adsorption has been reported; some accidental fires in the carbon bed due to the removal of high concentrations of ketones have been published. In this work, removal of VOCs was performed in a laboratory-scale pilot unit. In order to visualize the increase in local temperature, the adsorption front was tracked with a flame ionization detector and the thermal wave was simultaneously visualized with an infrared camera. In extreme conditions, fire in the adsorber and the combustion of activated carbon was achieved during ketone adsorption. Data have been extracted from these experiments, including local temperature, front velocity and carbon bed combustion conditions.

OBJECTIVE: To present a procedure for establishing treatment guidelines during pregnancy and, as an application of the method, the recommendations for treatment of pruritus. DESIGN: A preliminary survey was carried out among participants of the study group to determine drug choices for treatment of pruritus during pregnancy. Literature data on the selected drugs were analyzed. Recommendations for treatment were proposed, taking into account the most efficient agents and the least toxic for the fetus. This draft was submitted to all participants of the study group; criticism and suggestions were gathered. A new draft was evolved and repeatedly submitted to participants until consensus was reached. SETTING: Study group set up in southwestern France, with the help of national experts. PARTICIPANTS: Forty-three general practitioners, six gynecologists and/or obstetricians, five pharmacologists, two dermatologists, and an embryologist. RESULTS: The main recommendations for treatment of pruritus during pregnancy are to begin with topical treatment: emollient bath additives, moisturizing cream, talc. If insufficient, a systemic treatment should be added. Antihistamines are prescribed first: hydroxyzine or dexchlorpheniramine is used during the first 2 months. From the third month, the same agents can be used, as can mequitazine. The duration of treatment can be up to 10 days. The group's second choice was benzodiazepine (oxazepam) as second-line treatment. CONCLUSIONS: Strategies for treatment of diseases during pregnancy are not always well defined. For many common diseases, very few data are available concerning drug use in pregnant women. The study group, based on consensus among participants, proposed treatment guidelines.

Although much has been done to examine those factors associated with higher mortality among African American women, there is a paucity of literature that examines disparities among rural African Americans in South Carolina. The purpose of this investigation was to examine the association of race and mortality among breast cancer patients in a large cohort residing in South Carolina for which treatment regimens are standardized for all patients.Subjects included 1209 women diagnosed with breast cancer between 2000 and 2002 at a large, local hospital containing a comprehensive breast center. Kaplan-Meier survival curves were calculated to determine survival rates among African American and European American women, stratified by disease stage or other prognostic characteristics. Adjusting for various characteristics, Cox multivariate survival models were used to estimate the hazard ratio (HR).The 5-year overall all-cause mortality survival proportion was ∼78% for African American women and ∼89% for European American women, P0.01. In analyses of subpopulations of women with identical disease characteristics, African American women had significantly higher mortality than European American women for the same type of breast cancer disease. In multivariate models, African American women had significantly higher mortality than European American women for both breast cancer-specific death (HR, 2.41; 95% confidence interval [CI], 1.21-4.79) and all-cause mortality (HR, 1.42; 95% CI, 1.06-1.89).African American women residing in rural South Carolina had lower survival for breast cancer even after adjustment for disease-related prognostic characteristics. These findings support health interventions among African American breast cancer patients aimed at tertiary prevention strategies or further down-staging of disease at diagnosis.

Objectifs Peu d’etudes ont confronte la qualite de vie apres curietherapie (CuT) et apres prostatectomie radicale (PR) specialement concernant la fonction erectile (FE). Le but de cette etude etait de comparer la FE apres CuT et apres PR, et d’identifier les facteurs predictifs de dysfonction erectile (DE) chez des patients ayant un score IIEF5 initial > 16. Methodes Entre 01/2005 et 07/2012, 179 patients ont eu une CuT (grains libres, planimetrie en temps reel, dose prescrite : 160 Gy) et 739 ont eu une PR (un seul chirurgien experimente, conservation bilaterale : 75 % ; unilaterale : 22 % ; pas de conservation : 3 %). Les criteres d’inclusions etaient : cancer a faible risque ; 3 ; IIEF5 initial > 16 sans aide medicamenteuse. Tous les patients inclus etaient eligibles aux 2 traitements permettant de comparer 102 CuT a 203 PR. L’evaluation de la FE a ete faite prospectivement en preoperatoire, a 1 et 2 ans en utilisant l’auto-questionnaire IIEF5. Resultats Les patients du groupe PR etaient significativement plus jeunes [60,6 ans (± 6) vs 64,4 ans (± 6)] et avaient un score IIEF5 initial legerement plus eleve [22,3 (± 2,4) contre 21,4 (± 2,7)]. Cependant, a 1 et 2 ans, les proportions de patients ayant une FE satisfaisante (IIEF5 > 16) et les scores IIEF5 moyens etaient significativement superieurs apres CuT ( Tableau 1 ). De plus, la DE severe (IIEF5 Tableau 2 ). Conclusion Les troubles erectiles etaient courants apres prise en charge curative du cancer de prostate. Cependant, a moyen terme la DE etait plus frequente et plus severe apres PR qu’apres CuT.

Objectifs La curietherapie prostatique (CuT) est habituellement contre-indiquee si obstruction prostatique. La desobstruction par photovaporisation au laser Greenlight ® a minima (PVPm) avant CuT permet-elle de lever la contre-indication sans alterer la dosimetrie ? L’objectif etait d’evaluer prospectivement : sa faisabilite technique et la morbidite urinaire. Methodes De 04/2009 a 02/2014, 28 patients ayant un CaP (faible risque : 27/28) avec score IPSS > 15 et/ou debit maximum (Qmax) 15) etaient eligibles a la CuT (programmee au minimum 3 semaines plus tard) : ceci a ete possible pour 27/28 patients (96,4 %), âge moy. 66 ans, PSA moy. 6,9 ng/mL, vol. prostatique moy. 50 cm 3 . Le suivi mictionnel etait effectue prospectivement a 1, 3 et 12 mois par IPSS. Les questions 3, 5 et 6 (concernant l’obstruction) etaient analysees independamment. Resultats La PVPm a permis une amelioration significative de 60 % de l’IPSS et du Qmax. L’IPSS (Q3 + Q5 + Q6) moy. pre-PVPm etait de 6,3 vs 1,7 apres ( p Tableau 1 ; Fig. 1 ). Avec un recul moy. de 28 mois [3–58], ( n = 22 > 1 an), 3 patients (11 %) ont presente une retention aigue d’urines dont 2 ont necessite une intervention endoscopique. Tous les patients ont repris des mictions satisfaisantes. Aucune stenose uretrale n’a ete observee, ni incontinence. Conclusion La CuT etait realisable apres PVPm sans difficulte dosimetrique. Le risque de retention etait faible. Score IPSS moyen et Qvie etaient significativement meilleurs a 1 an par rapport a la situation avant PVPm. Cette strategie parait satisfaisante et demande a etre confirmee a plus grande echelle.

Alteration of the French R7T7 borosilicate glass in aqueous media may be described by a combination of equations governing surface reaction and diffusion mechanisms, with an empirical law of partial silicon retention in the alteration film. The dissolution process is controlled by the silicic acid activity at the interface between the gel and the pristine glass; the alteration film acts as a silicon diffusion barrier. The LIXIVER computer code describes the chronological evolution of the dissolution rates, the silicon concentrations at the reaction interface, and the concentrations of glass matrix components in solution between 0 and 300°C for various glass and solution compositions under static or dynamic leaching conditions. LIXIVER is not designed to model the long-term glass and solution behavior, but to investigate the effects of leaching parameters on the dissolution kinetics within a laboratory time frame (several months). This article discusses the results of modeling experiments, the principles behind the model, and simulations intended to qualify LIXIVER by specifying its scope of applications. An order of magnitude for the apparent silicon diffusion coefficient in the alteration film is proposed at 90°C for a glass-surface-area-to-solution-volume (SA/ V) ratio of 0.5 cm−1.

Resume Nous rapportons la quatrieme observation humaine confirmee de leishmaniose cutanee a Leishmania (Leishmania) amazonensis contractee en Guyane francaise. Elle s'est presentee sous la forme d'une lesion fessiere recidivante ayant necessite l'utilisation de trois cures d'isethionate de pentamidine et d'une cure intramusculaire d'antimoniate de N methylglucamine. La description clinique est completee par une revue de la litterature sur les aspects epidemiologiques, cliniques et therapeutiques des atteintes humaines a Leishmania (Leishmania) amazonensis.

Inverse modeling techniques used to quantify surface carbon fluxes commonly assume that the uncertainty of fossil fuel CO2 (FFCO2) emissions is negligible and that intra-annual variations can be neglected. To investigate these assumptions, we analyzed the differences between four fossil fuel emission maps with spatial and temporal differences over Europe and their impact on the model simulated CO2 concentration. Large temporal flux variations characterize the hourly fields (~40% and ~80% for the seasonal and diurnal cycles, peak-to-peak) and annual country totals differ by 10% on average and up to 40% for some countries (i.e., The Netherlands). These emissions have been prescribed to seven different transport models, resulting in 28 different FFCO2 concentrations fields. The modeled FFCO2 concentration time series at surface sites using time-varying emissions show larger seasonal cycles (+2 ppm at the Hungarian tall tower (HUN)) and smaller diurnal cycles in summer (−1 ppm at HUN) than when using constant emissions. The concentration range spanned by all simulations varies between stations, and is generally larger in winter (up to ~10 ppm peak-to-peak at HUN) than in summer (~5 ppm). The contribution of transport model differences to the simulated concentration std-dev is 2–3 times larger than the contribution of emission differences only, at typical European sites used in global inversions. These contributions to the hourly (monthly) std-dev's amount to ~1.2 (0.8) ppm and ~0.4 (0.3) ppm for transport and emissions, respectively. First comparisons of the modeled concentrations with 14C-based fossil fuel CO2 observations show that the large transport differences still hamper a quantitative evaluation/validation of the emission inventories. Changes in the estimated monthly biosphere flux (Fbio) over Europe, using two inverse modeling approaches, are relatively small (less that 5%) while changes in annual Fbio (up to ~0.15 Gt C/yr) are only slightly smaller than the differences in annual emission totals and around 30% of the mean European ecosystem carbon sink. These results point to an urgent need to improve not only the transport models but also the assumed spatial and temporal distribution of fossil fuel emission maps.

Aortoduodenal fistulas are rare and severe complications of aortic prostheses. The clinical picture usually includes digestive features and fever, unlike our observation where fistula was revealed by heavy and swollen leg with cutaneous septic abscesses but no digestive signs.A 59 year-old man who had undergone aortoiliac prosthetic repair of an aortic aneurysm 6 years earlier was hospitalized in a dermatology department for fever beginning three months previously associated with a heavy and swollen leg. Clinical and ultrasound examination revealed vascularised cutaneous nodules on the leg. Abdominal CAT showed left iliac venous compression caused by periprosthetic inflammation and particularly retroperitoneal fluid accumulation, gas bubbles in which suggested aortoduodenal fistula, which was confirmed during surgery. Aspirative puncture of abscesses was positive for E. Coli and Candida Glabatra.Aortoduodenal fistula is a rare complication of vascular prostheses. Clinical features include digestive symptoms and fever. However, diagnosis may be difficult and delay surgery. Cutaneous manifestations appear later and are often associated with other symptoms; they are caused by septic emboli or vascular compression. Imaging methods may assist diagnosis, but surgical procedures provide confirmation and form the cornerstone of management.

Objectifs Les biopsies prostatiques ciblees (BPc) pourraient etre plus precises pour le diagnostic de cancer de prostate (CaP) que les biopsies systematisees transrectales habituelles (BPs). Il a ete suggere que les BPc pouvaient augmenter la detection des CaP cliniquement significatifs (CaP-s) et diminuer la detection des CaP cliniquement non significatif. L’objectif de l’etude etait de comparer la performance des deux protocoles dans la detection des CaP. Methodes Entre 06/2013 et 02/2015, nous avons inclus de facon prospective tous les patients ayant suspicion de CaP et une IRM pre-biopsique (interpretee par un seul radiologue utilisant le score PIRADS). Tous les patients avaient des biopsies prostatiques systematisees echo-guidees par voie transrectale (10–12 biopsies) (BPs) puis des biopsies prostatiques ciblees (BPc) (2–4 biopsies/cible) avec fusion elastique echo/IRM utilisant UroStation™ (Koelis, Grenoble, France). Nous avons compare le taux de detection de CaP entre BPs et BPc. Les CaP-s etaient definis par : score de Gleason > 7 ou une longueur de cancer par biopsie > 4 mm. Resultats Quatre-vingt-deux patients ont ete inclus (au moins une lesion suspecte a l’IRM, PIRADS ≥ 2). Le taux de detection global de CaP etait : 57,3 % (47/82). Les taux de detection de CaP et de CaP-s etaient superieurs en cas de BPc (difference non significative) : 48,7 % vs 45,1 %, (p = 0,6) et 37,8 % vs 30,4 %, (p = 0,3) respectivement. En revanche, l’association BPc + BPs a permis de diagnostiquer significativement plus de CaP-s que les BPs seules : 46,3 % vs 30,5 % (p = 0,03). Par ailleurs, pour 15,8 % (13/82) des patients, le CaP-s etait uniquement detecte par les BPc. A l’inverse pour 8,5 % (7/82) des patients, le CaP-s etait uniquement detecte par les BPs. Le score de Gleason a ete augmente avec les BPc dans 23,1 % des patients (19/82) et dans 10,9 % (9/82) par les BPs. Conclusion Environ 16 % des patients ayant un CaP-s n’auraient pas ete diagnostiques en cas de BPs seules. L’utilisation de l’association BPc et BPs a detecte dans notre etude significativement plus de CaP-s. Combiner les 2 protocoles a permis un diagnostic et un pronostic plus precis que les BPs seules ce qui est capital lors du choix therapeutique ( Fig. 1 , Tableau 1 ).

Objectifs Definir comme pour la prostatectomie radicale un Trifecta (survie sans progression, continence et fonction erectile) a 2 ans apres curietherapie prostatique (CuT). Methodes De 08/2007 a 01/2013, 193 patients ont eu une CuT a bas debit par Iode-125 pour un adenocarcinome (CaP) a faible risque ou de risque intermediaire favorable. Nous avons etudie les patients : a bas risque, avec un score ICS initial nul, un score IIEF5 > 16, avec moins de la moitie des biopsies positives, absence de signe d’extension locale clinique et radiologique et un volume prostatique initial 3 (avant eventuelle hormonotherapie). Ainsi 100 patients ont pu etre analyses. La realisation du Trifecta etait definie par l’absence de recidive biologique (criteres de Phoenix), la continence (ICS = 0) et l’absence de dysfonction erectile significative (IIEF5 > 16). Resultats A 12 mois, 78 patients ont pu etre evalues et parmi eux l’objectif du Trifecta a ete atteint chez 35 patients (45 %) qui repondaient a l’ensemble des criteres. Chez 43 patients (55 %), l’ensemble des criteres du Trifecta n’etait pas obtenu, les principaux criteres d’echec etaient : la dysfonction erectile seule a 79 % (34/43), l’ICS a 7 % (3/43) et l’echec concomitant sur la continence et la fonction erectile a 14 % (6/43). A 24 mois ( n = 65), 51 % (33/65) repondaient au Trifecta. Parmi les 49 % d’echec (32/65), les principales causes etaient : la dysfonction erectile seule a 65,6 % (21/32), l’ICS a 18,8 % (6/32) et l’echec concomitant sur la continence et la fonction erectile a 15,6 % (5/32). Conclusion Le Trifecta peut etre utilise apres CuT pour les resultats oncologiques et fonctionnels meme s’il ne prend pas en compte certains effets secondaires specifiques (miction, symptomatologie rectale). Son utilisation permet en revanche une comparaison des differentes modalites de prise en charge des CaP. La toxicite erectile etait la principale cause d’echec du Trifecta apres CuT ( Tableau 1 ).